Provider Demographics
NPI:1326747452
Name:CHALUKIAN, RENATA (PEER SUPPORT)
Entity Type:Individual
Prefix:
First Name:RENATA
Middle Name:
Last Name:CHALUKIAN
Suffix:
Gender:F
Credentials:PEER SUPPORT
Other - Prefix:
Other - First Name:RENATA
Other - Middle Name:
Other - Last Name:WALLER,HOLDEN,AGEE,KOENIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2410 TURNER RD SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-2005
Mailing Address - Country:US
Mailing Address - Phone:458-203-9321
Mailing Address - Fax:
Practice Address - Street 1:1280 CENTER ST NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-4113
Practice Address - Country:US
Practice Address - Phone:503-507-4992
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-27
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR22-CRM-1480175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist